Health benefits of joint replacement surgery for patients with osteoarthritis: prospective evaluation using independent assessments in Scotland. (33/3242)

STUDY OBJECTIVES: To determine extent of change in psychological, functional, and social health after knee and hip joint replacement surgery using independent assessments. DESIGN: Patients were recruited before surgery and interviewed preoperatively, three months after surgery, and nine months after surgery. Interviews were conducted in the patients' own homes. SETTING: Two orthopaedic surgery units in Scotland. PARTICIPANTS: A consecutive sample of 107 patients with osteoarthritis having primary replacement of the knee or hip. MAIN OUTCOME MEASURES: Assessments of depression, anxiety, pain, functional activity, informal care, and formal service utilisation were made at three time points. MAIN RESULTS: Anxiety and pain were significantly reduced and functional activity levels significantly increased after surgery. While gains in anxiety and pain reduction occurred between the preoperative and three month assessments, gains in activity were made between the three month and nine month assessments. Although pain was reduced and activity increased, levels of depression were unchanged after surgery. Patients reported need for assistance with fewer activities after surgery, but increases in the use of formal services and increases in the number of hours per week of informal support received were observed at both three month and nine month follow up. CONCLUSIONS: The main benefit of joint replacement surgery is pain relief. Gains in functional activity, particularly mobility and leisure activities are made by many patients. Paradoxically, surgery for osteoarthritis seems to act as a "gateway" to increases in formal and informal community support, which are maintained into the longer term.  (+info)

The effects of shifts in the balance of care on general practice workload. (34/3242)

BACKGROUND: The consequences of the move towards a primary-care-led NHS are shifts in activity from secondary care to primary care and more involvement of GPs in purchasing decisions. Although there are many anecdotal reports of an increasing primary care workload, there is little empirical evidence on the extent of such shifts. This paper reports the results of a survey of GPs in Grampian, in the north-east of Scotland, in which we attempted to gather information on the effects of shifts in the balance of care on general practice. OBJECTIVE: We aimed to examine GPs perceptions of the extent to which general practice workload has changed due to planned and unplanned shifts in the balance of care. METHODS: The design of the study was a self-reported questionnaire, which was administered in general practices in the Grampian Health Board, Scotland. The subjects were senior partners of all general practices and the main outcome measures were the types of changes which have taken place in general practice, their source, their effect on practice workload and how practices have reacted. RESULTS: A 60% response rate was achieved (52/86); 85% (44/52) of GPs claimed that their workload had increased due to shifts in the balance of care and that 72% of the shifts were initiated outside the practice. Geriatric care, early discharge and psychiatric and psychology services, as well as nursing home care, were reported to have had the greatest impact on workload. The main aspects of practice workload which had increased included the number of GP consultations, general stress at work and number of home visits, whereas the net income of the practice and health outcome of patients were reported to have decreased. Practices have dealt with the increase in workload by shifting tasks from GPs to nurses and absorbing the workload into existing practices/patterns. Responders reported that ideally more nursing and GP staffing would be required. Overall, GPs welcomed the shifts in the balance of care, were more concerned about poor communication rather than actual increases in workload and claimed that morale had fallen. CONCLUSION: GPs perceive that the move towards a primary-care-led NHS is increasing the workload in general practice. If the shift in the balance of care away from secondary care is to be successful, then more information is required about such shifts to support practices as change continues.  (+info)

Patients' perceptions of medical urgency: does deprivation matter? (35/3242)

BACKGROUND: Consultation behaviour is recognized as having numerous determinants, but patients' perceptions of medical urgency have been neglected as a variable of potential importance. OBJECTIVES: We aimed to describe the variation in patients' perceptions of medical urgency, and to investigate the influence of socio-economic deprivation on such perceptions. We also aimed to investigate the association between patients' perceptions of urgency and their perception of doctor availability. METHODS: We carried out a questionnaire survey (incorporating 10 clinical vignettes) of patients attending one of 17 participating practices during a 1-week study period. A medical urgency score was calculated for each patient, and compared for patients sharing similar characteristics. The setting was West Lothian, Scotland. RESULTS: Patients' perceptions of medical urgency as measured by the urgency score were normally distributed amongst a sample of 4999 patients attending their GP. Whilst socio-economic deprivation was a significant determinant of perceptions of medical urgency, the effect was small and can probably be discounted as an important variable determining such perceptions. An association was observed between patients' perceptions of doctor availability following a non-urgent consultation request and a heightened sense of medical urgency. CONCLUSIONS: Further work is required to explain the differences in the population with regard to perceptions of medical urgency, and to examine the association between patients' perceptions of the seriousness of symptoms and the urgency of consultation requests.  (+info)

Association of medical, physiological, behavioural and socio-economic factors with elevated mortality in men of Irish heritage in West Scotland. (36/3242)

BACKGROUND: Men with patrilineal Irish descent from the immigrations of the nineteenth and twentieth centuries have higher death rates from 'all-causes' and, specifically, cardiovascular disease (CVD) than the general population of the West of Scotland. METHODS: A total of 5766 male employees from 27 workplace settings were examined between 1970 and 1973. Surname analysis identified 15 per cent of these men as of patrilineal Irish heritage. For those who have since died, the date and cause of death was obtained. Cox's proportional hazards model was used to compare the mortality risk of those with Irish and non-Irish surnames, and to investigate established medical, physiological, behavioural and socio-economic risk factors (acting in early and later life) as possible explanations for this excess mortality. RESULTS: The relative risk of death from all causes for the Irish of 1.26 (95 per cent confidence interval (CI) (1.12, 1.43)) was reduced to 1.12 (95 per cent CI (0.99, 1.26)) by including established risk factors in the model. The relative risk of CVD mortality of 1.51 (95 per cent CI (1.29, 1.77)) for the Irish was reduced to 1.35 (95 per cent CI (1.14, 1.58)) by the same adjustments. The elevated all-cause mortality of the Irish was mainly attributable to cardiovascular deaths. CONCLUSIONS: Cigarette smoking was only able to 'explain' a small amount of the excess all-cause and CVD mortality of men with patrilineal Irish descent. Relative deprivation during childhood and adulthood contributed to the high Irish mortality. However, there remains a substantial excess of premature deaths among Irish men which is unaccounted for by established risk factors.  (+info)

Epidemiological study of paratuberculosis in wild rabbits in Scotland. (37/3242)

A survey of 22 farms confirmed the presence of paratuberculosis in wild rabbits in Scotland. Regional differences were apparent in the prevalence of the disease in rabbits, with a significantly higher incidence occurring in the Tayside region. Statistical analysis showed a significant relationship between a previous history or current problem of paratuberculosis in cattle and the presence of paratuberculosis in rabbits on the farms. Molecular genetic typing techniques could not discriminate between selected rabbit and cattle isolates from the same or different farms, suggesting that the same strain may infect and cause disease in both species and that interspecies transmission may occur. The possibility of interspecies transmission and the involvement of wildlife in the epidemiology of paratuberculosis have important implications for the control of the disease.  (+info)

Role of the surgical trainee in upper gastrointestinal resectional surgery. (38/3242)

The 'New Deal' set out by the Department of Health in 1991, together with the introduction of specialist 6-year training grades by Calman in 1993, has resulted in a decrease in available training time for surgeons in the UK. There is also an emerging belief that surgical procedures performed by trainees might compromise patient outcome. This study examines the level of trainee experience in a specialist gastrointestinal unit and whether operation by a trainee surgeon adversely affects patient outcome. All patients in the University Department of Surgery, Royal Infirmary, Edinburgh, undergoing oesophagogastric, hepatic or pancreatic resection between January 1994 and December 1996 were entered into the study. The early clinical outcome (in-hospital mortality and morbidity, considered in three groups: anastomotic leak, other technique-related complications and non-technique-related complications) was evaluated with regard to the grade of surgeon (consultant or trainee) performing the operation. Of the 222 patients undergoing major upper gastrointestinal resection during the study period, 100 (45%) were operated on by trainees. Trainees were assisted and closely supervised by consultants in all but six resections. There was no major difference in mortality rate (consultant, 4.1% vs trainee, 5%), incidence of non-technique-related complications (consultant, 6.7% vs trainee, 7.1%), anastomotic leaks (consultant, 10.7% vs trainee, 5%) or technique-related complications (consultant, 18.9% vs trainee, 15%) between the two grades of surgeon. In a specialist unit, the early clinical outcome of patients undergoing major upper gastrointestinal resection by supervised trainees is no worse than in those operated on by consultants. Participation of trainees in such complex procedures enhances surgical training and does not jeopardise patient care.  (+info)

Association between asthma and family size between 1977 and 1994. (39/3242)

STUDY OBJECTIVES: Several recent reports show a negative association between asthma and family size or birth order, but this association was not detected in data collected between 10 and 30 years ago. This study compared the association between sibship size and asthma in three surveys using the same methodology in 1977, 1985/86, and 1993/94. DESIGN: Cross sectional comparison of the 1977, 1985/86, and 1993/94 surveys. SETTINGS: Study areas in England and Scotland. PARTICIPANTS: Parents of children between 5 to 11 years in England and Scotland were asked about asthma and bronchitis attacks in the last 12 months, and wheeze in their child. Approximately 9000 children participated in each of the surveys. RESULTS: The overall association between asthma, defined as asthma attacks or wheeze, and total number of siblings was not significant (p = 0.22), but an only child had a higher prevalence of asthma than children with siblings (OR 0.87 95% CI 0.76 to 0.98). The interaction between year of survey and sibship size on asthma was not significant (p = 0.36). There was no association between asthma and birth order. A significant interaction between social class and year of survey on asthma was detected (p = 0.004). In the 1993/94 survey children whose fathers had a semi or unskilled manual occupation had a higher prevalence of asthma (16%) than children whose fathers belonged to other social classes (13%). CONCLUSIONS: This study provides only marginal support for a change over time of the association between sibship size and asthma. Based on recent reports the nature of the exposure agent that may explain the association remains controversial. This study suggests a disproportionate increase of asthma in lower social classes.  (+info)

Injury surveillance in an accident and emergency department: a year in the life of CHIRPP. (40/3242)

BACKGROUND: The design of childhood injury prevention programmes is hindered by a dearth of valid and reliable information on injury frequency, cause, and outcome. A number of local injury surveillance systems have been developed to address this issue. One example is CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program), which has been imported into the accident and emergency department at the Royal Hospital for Sick Children, Glasgow. This paper examines a year of CHIRPP data. METHODS: A CHIRPP questionnaire was completed for 7940 children presenting in 1996 to the accident and emergency department with an injury or poisoning. The first part of the questionnaire was completed by the parent or accompanying adult, the second part by the clinician. These data were computerised and analysed using SPSSPC for Windows. RESULTS: Injuries commonly occurred in the child's own home, particularly in children aged 0-4 years. These children commonly presented with bruising, ingestions, and foreign bodies. With increasing age, higher proportions of children presented with injuries occurring outside the home. These were most commonly fractures, sprains, strains, and inflammation/oedema. Seasonal variations were evident, with presentations peaking in the summer. CONCLUSIONS: There are several limitations to the current CHIRPP system in Glasgow: it is not population based, only injuries presented to the accident and emergency department are included, and injury severity is not recorded. Nevertheless, CHIRPP is a valuable source of information on patterns of childhood injury. It offers local professionals a comprehensive dataset that may be used to develop, implement, and evaluate child injury prevention activities.  (+info)